SURGERY OF THE COLON
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SURGERY OF THE COLON

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SURGERY OF THE COLON SURGERY OF THE COLON Presentation Transcript

  • Surgery of the colon
  • anatomy
    • Cecum and appendix
    • Ascending colon
    • Transverse colon
    • Descending colon
    • Sigmoid colon
  • features
    • Liquid contents of the ileum to semisolid feaces
    • Large caliber
    • Appendices epiploica
    • Teania coli
    • Haustrations-sacculations
  • Right hemicolectomy
    • Indications
    • neoplasms of cecum
    • appendix adenocarcinoma
    • carcinoids > 2cm size
    • nodal metastasis
    • ascending colon
    • Diverticular desease of Rt side
    • Angiodysplastic liesions
  • Pre operative assessment
    • Complete blood count
    • LFT
    • Chest x ray
    • CEA
    • Synchronous lesions 2-8%
    • colonoscopy,double contrast Ba enema
    • CT scan optional
  • preparation
    • Liquid diet for 2 days
    • PEG
    • Antibiotics from day before
    • Hydration
    • DVT prophylaxis-heparin,pneumatic compression boots
  • Incision
    • Midline
    • Transverse
    • paramedian
  • Mobilisation of the RT colon
    • Assess the operability
    • pack the small bowel to the left
    • Retract the Rt colon to the midline
    • Incise parietal peritoneum-line of toldt
    • Mobilise the Rt colon to midline
    • Plane of dissection b/n retro peritoneal fat and mesentry
    • Ureter, gonadal vessel, IVC, duodenum
    • Mobilise the hepatic flexure, transverse colon
  • Bowel resection
    • Select the deviding point -ileum, tr.colon
    • Ileocolic, Rt colic, Rt branch of middle colic
    • Tr. Colon devided just to the Rt of main trunk of middle colic
    • 10 cms of terminal ileum
    • For hepatic flexure growth extended RHC, Lt branch of the middle colic also sacrificed
  • Anasthamosis
    • Hand sewn double layer
    • single layer
    • stapler
    • End to end
    • End to side
    • Side to side
  • Extended left hemicolectomy
    • Inf mesenteric artery ligated at the root
    • The distal transverse,splenic flexure,descending ,sigmoid and upper rectum are removed
    • Regional mesentericand pericolic LN are removed
    • In Lt HC Lt colic alone is ligated
    • For splenic flexure growth along with Lt colic Lt branch of middle colic also devided
    • Small bowel and sigmoid retracted cephalad and to the right
    • Descending colon retracted to the midline
    • Lateral peritoneum incised
    • Gonadal vessel, ureter are visualised
    • Mobilise the splenic flexure
    • Splenocolic ligament
    • Anasthamosis can be end to end, end to side,
    • or side to side
    • No tension at the site
    • Hand sewn
    • Stapler